CHANGES IN THE INVESTIGATION AND MANAGEMENT OF PRIMARY OPERABLE BREAST-CANCER IN VICTORIA

Objectives: To investigate the surgical practice and adjuvant therapie s used in the treatment of primary operable breast cancer in Victoria in 1990 and compare them with results of a similar study in 1986. Desi gn: All 856 cases of primary operable breast cancer registered by the Victorian Cancer Registry between 1 April and 30 September 1990 were i dentified. Each patient's surgeon was sent a standard questionnaire co vering diagnosis, investigations, operative procedures, adjuvant thera pies and reasons for certain management choices. Data were collected o n 89% of the patients from 176 participating surgeons. Results: Most p atients (82%) were referred to surgeons by general practitioners. Mamm ographic screening detected 14% of the cancers. The proportion of wome n receiving breast-conserving operations rose from 22% in 1986 to 42% in 1990. Surgeons operating on more than 20 breast cancers per annum w ere most likely to perform breast-conserving operations. The most comm on reasons given for nonconservative operations were the size of the t umour (37%), its central location (25%) and/or patient concern about t he risk of recurrence if the breast was to be conserved (22%). Among t hese patients, reconstruction was done at the time of primary treatmen t in 13%, subsequently in 2%, and was planned by another 5%. Of all pa tients, 33% were referred to a radiation oncologist and 24% actually r eceived radiotherapy (similar to 1986). Medical oncologists saw 33% of the patients and 20% of all patients received chemotherapy (similar t o 1986), which was given by a medical oncologist in 83% of the cases. Use of endocrine therapy increased from 20% in 1986 to 40% in 1990. Co nclusions: There has been a strong trend towards more conservative bre ast surgery in Victoria, with surgeons who are most active in breast c ancer surgery most likely to perform breast-conserving operations. Apa rt from a significant increase in the use of endocrine therapy, use of adjuvant therapies was unchanged from 1986.